1. General nursing diagnoses in the older adult
    1. Risk for loneliness related to isolation and loss of many friends and family members due to separation and death.
    2. Self-care deficit related to inability to complete activities of daily living.
    3. Impaired verbal communication related to hearing loss.
    4. Fluid volume deficit related to low fluid intake.
    5. Impaired skin integrity related to prolonged back-lying position and inability to turn self.
    6. Body image disturbance related to physical changes associated with the aging process.
    7. Sleep pattern disturbance related to concern about outcomes of pending diagnostic tests.

  2. Problems associated with the older adult
    1. Falls:
      1. Assessment. Risk factors:
        1. Gait changes - prone to trip and stumble; do not pick feet up as high.
        2. Postural instability - tendency to lose balance; older adults take steps to correct balance and increase possibility of falling.
        3. Impaired muscular control - inability to recover from trip or unexpected step; weaker muscle cushioning and slowed righting reflexes.
        4. Deterioration of vision and hearing - impaired obstacle avoidance.
        5. Loss of short-term memory - prone to trip over forgotten objects.
        6. Environmental:
          1. Home: unstable furniture and appliances; stairs with poor rails; throw rugs and frayed carpets; poor lighting; low beds and toilets; pets; objects on floor; medications.
          2. Institutions: recent admission or transter; furniture; slick, hard floors; unsupervised activities; meal times; absence of hand rails; inadequate lighting.
      2. Nursing goal/implementation: reduce risk of falling in the older adult with fall-prevention measures.
        1. Treat underlying condition (e.g., muscle weakness, imbalance, pain).
        2. Reduce risk factors (e.g., visual problems, orthostasis).
        3. Reduce environmental hazards.
        4. Increase leg range-of-motion (ROM) exercises.
        5. Develop an individualized exercise plan.
        6. Support adequate nutrition.
    2. Use of restraints:
      1. Definition - any device, material, or equipment attached to the patient that cannot be easily removed by the patient; restricts free movement; includes leg restraints, arm restraints, hand mitts, soft ties or vests, wheelchair safety bars, “geri-chairs.”
      2. Assessment of problems resulting from use of restraints:
        1. Increased agitation, confusion.
        2. Falls.
        3. Pressure sores.
        4. Bone density loss (demineralization).
        5. Immobility hazard.
        6. Death from strangulation.
      3. Nursing goal/implementation: provide restraint-free care with alternatives to restraints:
        1. Physical: recliners; medications for pain relief; seating adaptations (physical therapy/ occupational therapy); chairs with deep seats.
        2. Psychosocial: active listening; increased or decreased sensory stimulation; increased visiting; reality orientation.
        3. Activity: structured daily routines; wandering/pacing permitted; physical exercise; nighttime activities.
        4. Environmental: door buzzers; limb bracelet alarms; signs.
        5. Structural: exit alarms; increased lighting; enclosed courtyards.
        6. Supervision: family, nursing; volunteer; security.
        7. Sedation.
    3. Thermoregulation - normal oral temperature for >75 years: 96.9-98.3°F; rectal, 98-99°F. Decreased or absence of increased temperature in infection or dehydration.
      1. Assessment of causes:
        1. Factors affecting the hypothalmus: decreased - muscle activity, metabolic rate, food and fluid intake, subcutaneous fat; changes in peripheral blood flow; diseases; medications.